Inspection Reports for
Diversicare of Shelby
1108 Church Street, Shelby, MS, 38774
Back to Facility Profile25 Reports
Inspection Report — Jun 9, 2026
Complaint Investigation
Date: Jun 9, 2026
Visit Reason
The State Agency (SA) conducted a Complaint Investigation (CI) MS# 2965287, MS# 2978792, and MS# 3003993 at the facility on 6/9/26.
Complaint Details
Complaint Investigation (CI) MS# 2965287, MS# 2978792, and MS# 3003993 were conducted; the facility was found in compliance with no deficiencies cited.
Findings
The SA determined that the facility was in compliance with the requirements of participation in Medicare and Medicaid Services and there were no deficiencies cited.
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Complaint Investigations: 3
Inspection Report — Aug 12, 2025
Complaint Investigation
Date: Aug 12, 2025
Visit Reason
The State Agency conducted a Complaint Investigation (CI MS # 2576145) at the facility on 8/12/25. The SA investigated Quality of Care, Nursing Services, and Resident Rights.
Complaint Details
CI MS # 2576145: Complaint investigation regarding Quality of Care, Nursing Services, and Resident Rights was conducted and found to be unsubstantiated with no deficiencies cited.
Findings
The facility was found in compliance with the Mississippi Regulations for Minimum Standards for Institutions for Aged or Infirm. No deficiencies were cited.
Report Facts
Complaint investigations: 1
Inspection Report — Aug 12, 2025
Follow-Up
Date: Aug 12, 2025
Visit Reason
The State Agency conducted an onsite revisit survey at the facility on 8/12/25 to confirm that the facility had put measures in place to correct the deficient practice and sustain compliance with the Mississippi Regulations for Minimum Standards for Institutions for Aged or Infirm.
Findings
The survey confirmed the facility was in compliance and recommended that the facility be placed back in compliance effective 7/31/25.
Inspection Report — Jul 1, 2025
Annual Inspection
Date: Jul 1, 2025
Visit Reason
The State Agency (SA) conducted an annual recertification survey at the facility from 6/29/25 through 7/01/25. During the survey, the SA determined that the facility was not in compliance with Medicare and Medicaid requirements for participation and deficiencies were cited at F584, F656, F677, F851 and F880.
Findings
The facility was found not in compliance with Medicare and Medicaid requirements with deficiencies cited in maintaining a safe and homelike environment, care planning and ADL care, payroll staffing data submission, and infection prevention and control practices.
Deficiencies (5)
F0584 - Safe/clean/homelike environment. The facility failed to maintain a clean, safe, and homelike environment in one resident room with visible water damage and possible mold growth due to a leaking roof that had not been replaced.
F0656 - Develop/Implement Comprehensive Care Plan. The facility failed to implement a comprehensive care plan for nail care for one resident, resulting in long, jagged fingernails that were not trimmed as needed.
F0677 - ADL Care Provided for Dependent Residents. The facility failed to perform nail care for one resident requiring assistance with activities of daily living, despite the resident's request and staff acknowledgment.
F0851 - Payroll Based Journal. The facility failed to submit accurate Payroll-Based Journal staffing data for the 2nd quarter of 2025 due to manual entry errors and untimely updates, resulting in discrepancies in reported staffing hours.
F0880 - Infection Prevention & Control. The facility failed to use Enhanced Barrier Precautions for a resident with a peripherally inserted central catheter during medication administration, increasing the resident's risk of infection.
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Deficiencies cited: 5
Inspection Report — Apr 9, 2025
Complaint Investigation
Date: Apr 9, 2025
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The State Agency conducted a Complaint Investigation (CI MS #27719) at the facility on 4/9/25.
Complaint Details
Complaint Investigation CI MS #27719 was conducted and the facility was found in compliance with no deficiencies cited.
Findings
The facility was found in compliance with the Mississippi Regulations for Minimum Standards for Institutions for Aged or Infirm. There were no deficiencies cited.
Report Facts
Complaint investigations: 1
Inspection Report — Oct 9, 2024
Complaint Investigation
Date: Oct 9, 2024
Visit Reason
The State Agency conducted a complaint investigation (CI) for MS #26279 at the facility on 10/9/24.
Complaint Details
Complaint number CI MS#26279 was investigated and the facility was found in compliance with no deficiencies cited.
Findings
The facility was found in compliance with the Mississippi Regulations for Minimum Standards for Institutions for Aged or Infirm and there were no deficiencies cited.
Report Facts
Complaint investigations: 1
Inspection Report — Jul 1, 2024
Annual Inspection
Date: Jul 1, 2024
Visit Reason
On 07/01/24 the State Agency (SA) conducted a desk review of the information that was provided to our agency related to the annual survey that was completed on 05/22/24.
Findings
The information provided by the facility confirmed the facility was in compliance with the Minimum Standards of Operation for Institutions for the Aged or Infirm. The SA is recommending that your facility be placed back in compliance effective 06/27/24.
Inspection Report — Jul 1, 2024
Date: Jul 1, 2024
Visit Reason
On 07/01/24 the State Agency (SA) conducted a desk review of the information that was provided related to the annual survey completed on 05/22/24. The information confirmed the facility had put measures in place to correct the deficient practice and sustain compliance with Medicare and Medicaid requirements of participation.
Findings
The State Agency is recommending that the facility be placed back in compliance effective 06/27/24. No deficiencies were cited in this desk review.
Inspection Report — May 22, 2024
Annual Inspection
Date: May 22, 2024
Visit Reason
The State Agency conducted an annual recertification survey and a Complaint Investigation (CI) with one complaint, CI MS #24203, at the facility from 5/19/24 through 5/22/24.
Complaint Details
Complaint number CI MS #24203 alleged misappropriation of property. The SA determined the facility was in compliance and no deficiencies were cited related to this complaint.
Findings
The facility was found in compliance related to misappropriation of property for CI MS #24203 with no citations written. During the recertification survey, the facility was not in compliance with state licensure requirements and cited M635 for failure to administer enteral feeding according to physician's orders for one resident.
Deficiencies (1)
M635 - The facility failed to ensure a resident receiving enteral nutrition was administered feeding according to the physician's order, resulting in risk for dehydration, weight loss, and malnutrition.
Report Facts
Deficiencies cited: 1
Complaints investigated: 1
Inspection Report — May 22, 2024
Annual Inspection
Date: May 22, 2024
Visit Reason
The State Agency conducted an annual recertification survey and a Complaint Investigation (CI) with one complaint, CI MS #24203, at the facility from 5/19/24 through 5/22/24. The SA found the facility was in compliance related to misappropriation of property for CI MS #24203 with no citations written related to the CI. During the recertification survey, the SA determined the facility was not in compliance with Medicare and Medicaid requirements and cited F584, F641, F656, F693, and F851.
Complaint Details
Complaint CI MS #24203 related to misappropriation of property was investigated and found to be in compliance with no deficiencies cited.
Findings
The facility was found not in compliance with Medicare and Medicaid participation requirements, citing five deficiencies related to environment, assessments, care planning, tube feeding management, and payroll-based journal staffing data submission.
Deficiencies (5)
F0584 - The facility failed to provide blinds or window coverings in good repair for one of 60 resident rooms, specifically Room 34, where broken slats created an opening visible to the parking lot.
F0641 - The facility failed to accurately complete section P of the Minimum Data Set for one of four residents with a wander alert bracelet, Resident #24, by not coding the use of the wanderguard.
F0656 - The facility failed to implement a comprehensive care plan for a resident receiving enteral feeding (Resident #1) and failed to develop a care plan for a resident receiving antipsychotic medication (Resident #54).
F0693 - The facility failed to administer enteral feeding according to the physician's order for one of 11 residents with a feeding tube (Resident #1), resulting in the feeding pump being turned off contrary to the prescribed continuous feeding order.
F0851 - The facility failed to submit accurate staffing information into the Payroll-Based Journal system for the first quarter of 2024, due to exclusion of management personnel hours who covered shifts but were salaried and not included in payroll data.
Report Facts
Deficiencies cited: 5
Inspection Report — May 21, 2024
Life Safety
Date: May 21, 2024
Visit Reason
The facility was surveyed for compliance with the 2012 Edition of the Life Safety Code (LSC) of the National Fire Protection Association (NFPA).
Findings
The facility met the applicable provisions of the 2012 Edition of the Life Safety Code. There were no Life Safety Code deficiencies cited during this survey.
Inspection Report — Sep 6, 2023
Complaint Investigation
Date: Sep 6, 2023
Visit Reason
The State Agency conducted a complaint investigation CI MS# 22618 at the facility on 9/6/23.
Complaint Details
Complaint CI MS# 22618 was investigated and found to have no deficiencies. The SA did not identify non-compliance related to call bell response, dietary services, staffing, or residents being left wet.
Findings
The facility was found in compliance with Medicare and Medicaid participation requirements. No deficiencies were cited during this complaint survey.
Report Facts
Complaints investigated: 1
Inspection Report — Jul 26, 2023
Complaint Investigation
Date: Jul 26, 2023
Visit Reason
The State Agency conducted a complaint investigation, CI MS# 21523, at the facility from 7/25/23 through 7/26/23.
Complaint Details
Complaint CI MS# 21523 regarding Quality of Care and Treatment was investigated and found to be unsubstantiated with no deficiencies cited.
Findings
The facility was found in compliance with Medicare and Medicaid participation requirements with no deficiencies cited during the survey.
Report Facts
Complaint investigations: 1
Inspection Report — Mar 28, 2023
Complaint Investigation
Date: Mar 28, 2023
Visit Reason
The State Agency conducted a complaint survey, MS #20970, from 3/27/23 to 3/28/23 regarding neglect, pressure ulcers and activities of daily living.
Complaint Details
Complaint MS #20970 for neglect, pressure ulcers and activities of daily living was investigated and found to be unsubstantiated with no deficiencies cited.
Findings
The facility was found in compliance with the Mississippi Regulations for Minimum Standards for Institutions for Aged or Infirm with no deficiencies cited.
Report Facts
Complaint number: 20970
Inspection Report — Mar 20, 2023
Complaint Investigation
Date: Mar 20, 2023
Visit Reason
The State Agency conducted two complaint investigations (CI MS #20947 and CI MS #20968) at the facility on 03/20/23.
Complaint Details
Two complaint investigations were conducted: CI MS #20947 related to non-palatable and insufficient food, and CI MS #20968 related to unclean environment. Both complaints were found to have no deficiencies cited.
Findings
The facility was found in compliance with Medicare and Medicaid Services requirements. No deficiencies were cited for either complaint regarding non-palatable and insufficient food or unclean environment.
Report Facts
Complaints investigated: 2
Inspection Report — Feb 21, 2023
Annual Inspection
Date: Feb 21, 2023
Visit Reason
On 02/21/23 the State Agency (SA) conducted a desk review of the information that was provided to our agency related to the annual survey that was completed on 01/05/23.
Findings
The information provided by the facility confirmed the facility had put measures in place to correct the deficient practice and sustain compliance with Medicare and Medicaid requirements of participation. The SA is recommending that your facility be placed back in compliance effective 02/10/23.
Inspection Report — Jan 5, 2023
Life Safety
Date: Jan 5, 2023
Visit Reason
The facility was surveyed for compliance with the 2012 Edition of the Life Safety Code (LSC) of the National Fire Protection Association (NFPA).
Findings
The facility was found to meet the applicable provisions of the 2012 Edition of the Life Safety Code. There were no Life Safety Code deficiencies cited during this survey.
Inspection Report — Jan 5, 2023
Annual Inspection
Date: Jan 5, 2023
Visit Reason
The State Agency conducted an annual re-certification survey at the facility from 1/3/2023 to 1/5/2023. During the survey, the facility was found not in compliance with Medicare and Medicaid regulations with a deficiency cited at F644.
Findings
F0644 - Coordination of PASARR and Assessments. The facility failed to refer Resident #16 for a Level II PASARR following an inpatient Geri-psych admission with a new psychiatric diagnosis and new psychiatric medications. There was no Change in Status Form submitted for this resident, potentially limiting access to needed mental health services.
Deficiencies (1)
F0644 - Coordination of PASARR and Assessments. The facility failed to refer a resident to the appropriate agency for a Level II PASARR following an inpatient Geri-psych admission with a new psychiatric diagnosis and new psychiatric medications, as evidenced by missing Change in Status Forms and staff interviews.
Report Facts
Deficiencies cited: 1
Inspection Report — Oct 31, 2022
Complaint Investigation
Date: Oct 31, 2022
Visit Reason
The State Agency conducted a complaint survey MS #19684 on 10/31/22 regarding pressure ulcer prevention.
Complaint Details
Complaint MS #19684 regarding pressure ulcer prevention was investigated and not substantiated; no deficiencies cited.
Findings
The complaint was not substantiated and no deficiencies were cited. The facility was found in compliance with Medicare and Medicaid requirements.
Report Facts
Deficiencies cited: 0
Inspection Report — Apr 8, 2022
Complaint Investigation
Date: Apr 8, 2022
Visit Reason
The State Agency conducted complaint survey for CI MS #18570 and CI MS #18291 at the facility from 04/07/2022 to 04/08/2022 along with an Employee Vaccination section of the Infection Control survey.
Complaint Details
Complaint numbers CI MS #18570 and CI MS #18291 were investigated; both were not substantiated and no deficiencies were cited.
Findings
The facility was found to be in compliance with the Minimum Standards for the Institutions for the Aged or Infirm. The SA did not substantiate noncompliance with CI MS #18570 related to Admission, Transfer, and Discharge Rights or CI MS #18291 related to Injury of unknown origin and no deficiencies were cited.
Inspection Report — Jul 22, 2021
Complaint Investigation
Date: Jul 22, 2021
Visit Reason
On 07/21/2021 the State Agency (SA) conducted an on-site complaint investigation, CI MS #17885, which alleged that the facility was not implementing the current standards for visitation with residents; resident care was not performed; the facility was not kept clean and tidy; staffing numbers were too low to care for residents; resident Trust Fund accounts were not accessible to residents; residents were not bathed/showered on a regular schedule and the residents' hair was not washed and groomed; among other Activity of Daily Living (ADL) concerns.
Complaint Details
CI MS #17885 alleged multiple deficiencies including visitation standards, resident care, cleanliness, staffing, Trust Fund access, and ADL concerns. The complaint was unsubstantiated and no deficiencies were cited.
Findings
The State Agency unsubstantiated all of the alleged complaints, CI MS #17885. The facility was determined to be in compliance with the standards for participation in Medicare and Medicaid and no deficiencies were cited related to CI MS #17885.
Report Facts
Complaint investigations: 1
Inspection Report — May 21, 2021
Complaint Investigation
Date: May 21, 2021
Visit Reason
The State Agency conducted complaint investigations (CI MS #17632, CI MS #17550, CI MS #17552, and CI MS #17311) from 5/20/21 through 5/21/21.
Complaint Details
Four complaint investigations (CI MS #17632, CI MS #17550, CI MS #17552, and CI MS #17311) were conducted and none were substantiated for resident rights, quality of care/treatment, accidents, or responsible party notifications.
Findings
The facility was found to be in compliance with the Minimum Standards for the Aged or Infirm. No deficiencies were cited.
Report Facts
Complaint investigations: 4
Inspection Report — May 29, 2020
Routine
Date: May 29, 2020
Visit Reason
A Covid-19 Focused Infection Control Survey was conducted by the State Agency (SA) on 5/29/20.
Findings
The facility was found to be in compliance with 42 CFR §483.80 infection control regulations and has implemented the CMS and Centers for Disease Control and Prevention (CDC) recommended practices to prepare for COVID-19.
Inspection Report — Oct 11, 2019
Annual Inspection
Date: Oct 11, 2019
Visit Reason
The State Agency (SA) conducted an annual recertification along with a complaint, MS #15712, from 10/7/2019 to 10/11/2019. During the survey, the SA determined that the facility was not in compliance with the requirements of participation in Medicare and Medicaid. The SA substantiated MS #15712 for Unnecessary Medications and cited F758 related to the complaint. The SA also cited F640 and F641, during the recertification survey.
Complaint Details
Complaint MS #15712 was substantiated for Unnecessary Medications with deficiency F758 cited related to the complaint.
Findings
The facility was found not in compliance with deficiencies cited for untimely transmission of Minimum Data Set (MDS) assessments, inaccurate coding of MDS assessments, and failure to limit PRN antipsychotic medication orders to 14 days without physician reassessment. The facility failed to complete and transmit timely MDS assessments for multiple residents and inaccurately coded assessments for several residents. Additionally, the facility did not ensure proper management of psychotropic medications for one resident.
Deficiencies (3)
F0640 - Encoding/Transmitting Resident Assessments. The facility failed to transmit Minimum Data Set (MDS) assessments timely for three residents, including late submission of entry and discharge assessments.
F0641 - Accuracy of Assessments. The facility failed to accurately code MDS assessments for four residents, including errors in coding gastrostomy tubes, pressure ulcers, insulin injections, and anticoagulant therapy.
F0758 - Free from Unnecessary Psychotropic Medications/PRN Use. The facility failed to limit PRN antipsychotic medication orders to 14 days without physician reassessment and did not decrease an antipsychotic medication per physician order for one resident.
Report Facts
Deficiencies cited: 3
Inspection Report — Nov 9, 2018
Annual Inspection
Date: Nov 9, 2018
Visit Reason
The annual recertification survey of 11/7-9/18 revealed the facility was in substantial compliance and has met all requirements of 42 CFR Part 483 with no health deficiencies cited.
Findings
The facility was found in substantial compliance with no health deficiencies cited during the annual recertification survey.
Report Facts
Deficiencies cited: 0
3 CMS Surveys
CMS Survey — Jan 5, 2023
Jan 5, 2023
CMS Survey — May 22, 2024
May 22, 2024
CMS Survey — Jul 1, 2025
Jul 1, 2025
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